If the fundus is midline but remains boggy after massage, what is the next step?

• A. Wait and hope it improves.
• B. Reassess for bladder distention, continue massage, and notify the provider for additional interventions.
• C. Apply ice to the lower abdomen.
• D. Discontinue all uterotonic medications.

Answer: (B)

Postpartum uterine atony is when the uterus remains soft and lacks tone, which can lead to heavy bleeding. If the fundus stays boggy after massage, the next step is to assess for bladder distention, because a full bladder can prevent the uterus from contracting and keep it soft. If the bladder is distended, empty it (or assist the patient to void) and then continue fundal massage while monitoring for ongoing bleeding. At the same time, promptly notify the provider so additional interventions—such as uterotonic medications and further treatments—can be started as needed. Delaying action, applying ice, or stopping uterotonic medications would not address the underlying issue.